48 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Table III Self Perception With and Without Cosmetics: Results of Univariate Analyses of Variance Followed by Comparison of Means Tests for Dimensions of Self Perception Significantly Affected by Make-Overs, for High and Low* p.a. Groups Low p.a. High p.a. Control Gp. P Phys. attractive/phys. unattractive 1.88 1.25 0. ! 3 Well, healthy/not well, not healthy 2. !3 0.50 - 0.25 Feel like going out/don't feel like going out 2.88 1.13 0.03 Confident/shy, reticent 1.63 1.0 - 0. !2 Optimistic/pessimistic 1.63 - 0.25 0.38 Confident in appearance/not confident in appearance 1.75 0.88 - 0.87 Happy to look at self in mirror/ prefer not to look at self 2.50 1.50 -0.87 Outlook on life: positive/negative 0.38 0.63 4.14 Want to be seen/don't want to be seen 2.63 1.13 0.00 Attitude to make-over sessions 2.88 3.13 0.38 Would be glad to see people/ prefer not to see people !.0 0.63 -0.75 0.05 0.025 0.05 0.025 0.05 0.05 0.001 0.01 0.05 0.01 0.05 * p.a. -- physical attractiveness Scores shown are mean "difference" scores ("difference" refers to the result of subtracting the score for the "before" rating from the score for the "after" rating for each subject: the mean across subjects is shown for each scale). means tests are shown in Table III. We feel that long-term training in ef•ctive use of make up should be introduced as a vehicle for self care to help the elderly to take a more positive attitude towards themselves and their appearance. Kastenbaum (11) has argued that improved care of the appearance would help to in- crease the self and social acceptance of old people and help prevent the self-destructive vicious cycle of self abandonment. The research described above now provides some support for this notion in that we now know that use of cosmetics enhances positive perception by others and enhances self-perception. Positive social feedback should, in turn, enhance the self image further. Thus the development of a positive psychological cycle is encouraged (positive feedback and a strengthened self image generating more positive attitudes and behavior and leading to a feeling of enhanced well being, which in turn elicits further positive feedback, and so on, in a self-perpetuating cycle) instead of a negative self-destructive type of cycle. COSMETIC THERAPY We feel that cosmetic programs to improve the psychological and social well being of elderly persons, particularly the unattractive elderly, are worthy of more serious atten- tion. They deserve the status of a therapeutic modality. We have developed, from our research, the new concept of "cosmetic therapy," combining psychology and cosmetics in some form. Cosmetic therapy programs can be as simple as applying ordinary make- up or they can involve expert professional help in which cosmetics are used as a vehicle

COSMETIC THERAPY FOR SKIN 49 to rebuild self image and confidence after disfiguring accidents. Cosmetic therapy pro- grams can moderate anxiety over appearance and increase opportunities for enjoying some of the advantages of looking attractive. Individual cosmetic therapy programs are likely to be particularly helpful for those suffering from depression (12,13) and for those who simply need a psychological boost. It is also appropriate for the special needs of those with skin disorders and disfigure- ments that need camouflaging (skin diseases, scars, post-plastic surgery problems, aging skin, etc.) (14). Those who are unattractive or have visible defects or disfigurements are disadvantaged socially and psychologically (15). Thus cosmetic changes to the appearance become very important in helping to restore the balance and to give more individuals the opportu- nity to enjoy the advantages of looking attractive or at least looking fairly normal and average in appearance. The British Red Cross started an innovative program of beauty care for people who are hospitalized, the elderly, the depressed, and those in need of a psychological boost. We have also linked up with the British Red Cross (16) to add the psychological dimension to the training programs for their cosmetic service of giving make-overs, skin care, massage, and manicures to hospital patients, including those with skin defects and disfigurements, who are in need of additional psychological support (17). We have helped them to extend their program to incorporate training in the psychological aspects of their work. This Red Cross cosmetic program has also expanded to other countries including Australia, New Zealand and, fairly recently, Japan. We have tried to encourage the development of a similar service in the United States through the American Red Cross. In our research in the U.S. we have developed a program of cosmetic therapy for disfi- gured burn victims, many of whom can be severely disfigured--as a means of helping them to develop coping mechanisms to recover from burn injury--since they fre- quently report that it is discomfort and negative reactions of others to negative appear- ance that is the cause of most of their distress. As with the elderly, it is the stigma associated with unattractive appearance that is a major cause of social disadvantage and, again, cosmetics of all kinds provide a powerful vehicle to alleviate at least some of the suffering. Camouflage and color cosmetics are important in effecting positive psycho- logical change in this group. Academic discussions of coping mechanisms for the disfig- ured now pay attention to the important role that cosmetics can play in developing coping strategies. in an exploratory study of the effect of our cosmetic therapy programs on a psychiatric population across the life span, consisting mainly of depressives but also including patients who suffered from self-image-related disorders such as anorexia nervosa and bulimia (13), the change in mood state within the hospital setting was readily notice- able, often appearing to speed recovery. The concept of cosmetic therapy is based on the notion of working with the patient or subject to build or rebuild the level of confidence and self esteem and a positive self image by training the person to disguise defective aspects and to enhance positive aspects of appearance as a vehicle to help her psychologically. Part of the cosmetic therapy program involves training in the use of cosmetic camouflage to correct defor-